Telemedicine as support for primary care referrals to neurologists: decision-making between different specialists when guiding the case over the phone

Abstract

Background: Brazil’s public health system, the largest in the world, faces great challenges in establishing access to specialized care for all Brazilians. “Regula Mais Brasil” is a structuring project from the Ministry of Health that aims to optimize the referral process for specialized care throughout Brazil and uses telemedicine to support primary care physicians. The high demand for support and referrals in the neurology specialty raises questions about what the difficulties and doubts in managing these patients are and whether the training of the coordinating physician influences the orientation and outcome of referral. Methods: In a retrospective analysis on a database, all teleconsultations in the neurology specialty were evaluated. The diagnoses were categorized using the ICD-10 and according to the specialty of the coordinating teleconsultant for multiple comparisons. Results: In total, 1687 teleconsultations were conducted between January 10 and December 2, 2019, in the cities of Belo Horizonte and Porto Alegre and in the Federal District. The most frequent area of doubt for doctors was about epilepsy. After discussion via telemedicine, 25% of the referrals were avoided and the specialty of the teleconsultant physician did not impact the decision made: 72.3, 72.6 and 66.5%, in relation to approval by neurologists, family doctors and other experts, respectively. Conclusion: Increasing access to specialists, not only for patients but also for doctors, helps in achieving early resolution of issues of greater difficulty for primary healthcare doctors, thus resulting in lower numbers of referrals.

Teleconsultations in neurology in a universal health system amid COVID-19: a descriptive study

“…This may explain the high predominance of females (78.6% of cases), since migraine and some other types of headache are more frequent among women 11 . The high frequency of headache cases among all health conditions imposing referrals to neurologists was reported by previous studies 7,[11][12][13] . The profile of most prescribed medications could also be explained by the dominance of migraine cases.…”

“…Telemedicine was impressively catalyzed by COVID-19 as a viable alternative given the challenge of increasing access to health care while preventing agglomerations, especially after the unprecedented approval of telehealth in a wider context during the pandemic by the Brazilian Federal Government through publication of Federal Law no. 13.989 in April 15, 2020 6 .…”

Telemedicine use among neurologists before and during COVID-19 pandemic

“…The participants were from all regions of Brazil, the majority from the Southeast (58.6%). The five states with the largest number of participants were São Paulo (53), Minas Gerais (23), Rio Grande do Sul (17), Rio de Janeiro (15), and Bahia (7).…”

“…It is important that these complimentary uses of telemedicine, such as exchanging messages with patients and using mobile videos for epileptic attacks recognition 11,12 , be recognized as telemedicine procedures that are subject to regulation, so that they can be carried out with safety for patients and neurologists. Some previous Brazilian experiences with telemedicine have been published, including the Belo Horizonte-Telehealth (BH-Telehealth) Program 13 , teledermatology in primary care in São Paulo 14 , neurology teleinterconsultation in three capitals in Brazil 15 , the TelessaúdeRS-UFRGS 16 program for teleregulation of care 17 , neurosurgery emergency consultation 18 , teleophthalmology in primary care 19 , and medical support by teleconsultation in emergency departments 20 . Most of these initiatives have government support through public universities or hospitals that are members of the Institutional Development Support Program of the Unified Health System (PROADI-SUS).…”

Telemedicine in neurology: advances and possibilities

“…Mantese et al evaluated 1,687 teleconsultations on patients with neurological complaints and showed that telehealth support could avoid 29% of referrals for neurology. The main reason for teleconsultation was epilepsy or seizure (25%), followed by headache (20%), stroke (10%), tremor or parkinsonism (7%) and cognitive disorders (6%) 52 .…”